State Plan Attachment: 4.11(a) Results of Comprehensive Statewide

The Iowa Department for the Blind's mission is to be the means for persons who are blind to obtain for themselves universal accessibility and full participation as citizens in whatever roles they may choose, including roles that improve Iowa's economic growth. The Department understands that, in order to realize this mission, it must continuously modify its programs to meet the needs of its customers and changing socioeconomic conditions.

In 2009, the Department completed its mandated triennial comprehensive assessment to determine the current needs of Iowans who are blind or visually impaired and to assess the services provided by Community Rehabilitation Programs (CRP).

Methodology

The Department's comprehensive assessment was designed to determine the rehabilitation needs of Iowans who are blind or visually impaired; identify and serve these individuals who are minorities or who are unserved and underserved by the vocational rehabilitation system; evaluate the methods used to provide supported employment services under 34 CFR part 363; and identify the needs of Iowans who are blind or visually impaired served through other components of the statewide workforce investment system. The assessment also sought to identify the need to establish, develop, or improve community rehabilitation programs within the state.

The results of the needs assessment are based on an analysis of information obtained from these sources:

Iowa's population and demographic data;
4 years of the Department's Vocational Rehabilitation (VR) case closure data;
Rehabilitation Services Administration (RSA) monitoring tables;
Survey results; and
Public comments.

Population and Demographic Data. A profile of Iowa's population was built using data from the National Eye Institute, several American Community Surveys, U.S. Census Bureau Interim Population Projections reports, and other federal reports. Additional data was collected from Iowa's State Data Center, Veteran's Administration, Department of Human Services, and Workforce Development. Staff compared this data with the Department's VR closure data collected by its case management system (eFORCE). Population data was collected for these categories: gender, age, race, educational attainment, location of residence, and veteran status.

eFORCE Case Closure Data. Staff collected and analyzed its VR case closure data from federal fiscal years 2005 through 2008 to determine whether the Department's VR clients were demographically proportionate to Iowa's population. This data was also analyzed to determine employment trends for the population categories defined above. Data was collected for the following categories to determine employment and service trends:

Closed while an applicant but before eligibility determination (Status 08).
Closed after employment outcome achieved (Status 26).
Closed after services initiated without employment outcome (Status 28).
Closed after determination of eligibility but before services under Individualized Plan for Employment (IPE) initiated (Status 30-5).
Closed after determination of eligibility but before IPE developed (Status 30-7).

Rehabilitation Services Administration (RSA) Monitoring Tables. In February 2009, Rehabilitation Services Administration staff completed its on-site visit to the Department as part of the Section 107 Monitoring Review. Prior to the on-site visit, Department staff received and reviewed 38 data tables related to the VR program and 25 data tables related specifically to the transition population. Data from these tables were also used to assess service trends.

Survey Results. In April 2009, the Department sent a survey to Community Rehabilitation Programs (CRPs) throughout the state. The survey's questions related to the number of blind and visually impaired Iowans served, a self-assessment of the organization's ability to provide employment-related services to blind and visually impaired Iowans, and referrals to and collaboration with the Department. The survey also presented the CRP with the opportunity to request training or information from the Department. The results of that survey can be found under the assessment of CRPs section below.

In addition, responses from five years of client satisfaction surveys were reviewed. This fourteen-question survey asked clients to indicate their understanding of the VR process, satisfaction with service delivery by Department staff, knowledge of other resources, identification of the services they found most helpful, and an assessment regarding their attitude toward blindness, independence, and confidence following case closure. An analysis of survey results is under the "Satisfaction with VR Services" heading below.

Public Comment. The Department receives input from consumers regarding their needs from a variety of on-going activities. The consumer organizations are very active in Iowa, and they routinely provide input to the Department and to the Iowa Commission for the Blind. Indeed, Department staff are invited to present and participate in the consumer organizations' annual statewide conventions. Resolutions from these conventions that pertain to the Department are presented to the Director and the members of the Commission. In addition, the Commission holds four to six board meetings each year. These meetings are open to the public and time can be reserved on the agenda for any Iowan who wants to bring an issue before the board. Finally, staff obtain information at the local level by participating in support group meetings around the state.

A public hearing to obtain feedback on the results of this needs assessment and on other topics was held on April 18, 2009.

Consumer feedback from these sources was utilized in formulating goals for the next three years.

Assessment Results

The data provided by RSA staff for the monitoring review showed that the Department achieves high performance in several areas compared to other blind agencies. The Department's employment rate remains in the 80% range, compared with the low 70% range for other blind agencies. The Department also performs better than most blind agencies in these categories:

Average wage at closure;
Average hours worked per week;
Percentage of clients closed working at Substantial Gainful Activity (SGA) level at 35 hours or more per week; and
Percentage of clients closed with employer-provided medical insurance.

The Department consistently performs well on the federal Standards and Indicators. (The Department's, as well as all VR agencies', performance data can be found on RSA's web site at http://rsamis.ed.gov.)

The Department is proud of its achievements, yet we seek ways to improve performance. The needs assessment revealed areas where the Department excels and areas where improvements can be made.

Percentage of Potential VR Population Served
The 2008 population projections estimate Iowa's total population is 2,997,608. Of that number, 66% of Iowans are between the ages of 14 and 64. The total population age 16 and over in the labor force is 1,611,994. In March 2009, Iowa's unemployment rate was 5.2%, which is 1.3% higher than March 2008.

A precise number of blind and visually impaired Iowans does not exist. The National Eye Institute (NEI) estimates that 48,944 Iowans age 40 and older are blind or have a visual impairment, of that total, 26,897 are blind. The NEI put the prevalence rate for visual impairment, including blindness, among Iowans 40 and older at 3.73%. Alternatively, projections from the National Health Interview Survey on Disability estimate that the number of Iowans who are blind or visually impaired will be 69,422 by 2010, of that number 10,256 represent blind Iowans. (The term "visually impaired" here means has difficulty seeing even with eyeglasses or contact lenses.)

The number of Iowans who may require VR services from the Department is estimated to be 45,819, including 6,769 (blind) and 39,050 (visually impaired). These estimates were derived by multiplying the National Health Interview Survey on Disability data by the percentage (66%) of Iowans who are between the ages of 14 and 64 (i.e. 10,256*.66 = 6,769; 59,166*.66 = 39,050). The National Health Interview Survey data was used for this estimation because its data looked at the population as a whole, not at an age specific data set. NEI's data shows that the prevalence of vision loss, including blindness, dramatically increases after age 75. Therefore the NEI's 3.73% prevalence rate would be an overestimation for a younger, VR potential age group. (The Department has and will continue to provide VR services to Iowans over the age of 64 who require them.)

The Department has experienced a diminished presence in the state. While the state's population as a whole has increased at a rate of 2% since 2003, the Department has seen a steady decrease in referrals and applicants per million since FY2003. Applications for VR services have dropped from 74 per million in FY2003 to 51 per million in FY2008 (RSA 107 Monitoring Table 1: VR Case Flow Information). According to caseload data from FY2008, the Department is serving about 6.5% of the estimated pool of potentially VR-eligible Iowans who are blind. This data indicates that the Department needs to increase outreach efforts in order to reach those Iowans who are blind or visually impaired and require VR service to obtain or maintain employment.

Demographic Representation and Outcomes in VR Case Closures FFY2005 - 2008
The closure data from federal fiscal years 2005 through 2008 shows that, in many ways, the demographic profile of the Department's VR clients mirrors that of Iowa's population.

Gender
Females make up 51% of Iowa's population, males 49%. Females age 16 and over represent 47.33% (762,903) of individuals in the labor force. The Department has been serving male and female clients in relative proportion to their representation in the state. The four year average shows that 52% of closed cases were males and 48% were female. In FY2008, 49% of closed cases were males and 51% were female.

In terms of employment outcomes, women tend to close more successfully than men. The four year average shows that men closed successfully (status 26) 60% of the time; women closed successfully 66% of the time. Men closed unsuccessfully (status 28) at a rate of 17%; women closed unsuccessfully (status 28) at a rate of 14%.

Age
Persons aged 45 to 54 represent the largest age group in Iowa (14.65%), followed closely by 14-24 (13.50%) and 25-34 year olds (13.16%). The median age in Iowa is 38. The Department's closure data again shows that it is serving Iowans in proportion to their representation in the state. Persons aged 45-54 represent the largest age group in the VR case closure data, followed by persons aged 35-44 and 25-34. Older individuals are represented a bit higher in the Department's VR case load in comparison to their representation in the state. This higher percentage is likely due to blindness and vision loss being age-related conditions.

Closure status data shows that young adults are not closing as successfully as their older counterparts. The percentage of clients closed between ages 14-24 who close successfully (status 26) has been dropping; on average 43% of these clients close successfully. Only 29% closed status 26 in 2008 as compared to 53% in FY2006. On average, they closed Status 28 - Unsuccessful 27% of the time. (The remainder accounts for cases closed ineligible or before an IPE was developed or services began.)

Clients aged 25-34 fared better. On average, they achieve a successful (status 26) closure 57% of the time. They close Status 28 - Unsuccessful 21% of the time.

Clients aged 45-54 closed successfully 66% on average and close unsuccessfully 11% on average. The average age of a status 26 closure is 45; average age for a status 28 closure is 37.

Many factors contribute to the employment status of young adults, including work experience, availability of entry-level jobs, and skills. A report titled The State of Working Iowa 2008 by the Iowa Policy Project shows that Iowa has only slowly recovered from the last recessionary period of 2001 to 2003. Not only were fewer jobs added to Iowa's economy following this recessionary period, but those jobs offered low wages and few if any benefits. Indeed, the authors found that the last recession-recovery period made Iowa's low wage problem worse. This study also found that younger (18-34) and less educated workers sustained the greatest losses in terms of opportunities for high-wage entry level jobs. The impact of the current recession has not yet been determined. Nonetheless, the Department needs to focus efforts on young adults to ensure they attain the work experience they need in order to be successful later in life.

Services to Minorities
Iowans are primarily white, with 94% reporting white as their race. Persons of Hispanic or Latino origin represent 4% of Iowa's population with black persons representing 2.6%. A small percentage of Iowans are Asian (1.6%) or American Indian or Alaska Native (.4%). A 2007 Labor Force Study by Iowa Workforce Development lists the unemployment rate for minorities as 9.2%.

The Department's closure population is somewhat more diverse than Iowa's population. However, we tend to have an under-representation of Hispanics given Iowa's population. The following list contains the average representation in VR closures by race:

White: 90.11%
Black/African American: 5.98%
Hispanic or Latino: 1.59%
Asian: 1.46%
American Indian: 0.86%

Outreach efforts targeted at the Hispanic population may yield a higher representation on the caseload.

Establishing employment trend data for minorities is made difficult by the small numbers they represent in the caseload. For example, while clients of Hispanic or Latino origin make up 1.59% of the case closures on average, the total number of these clients closed in four years is thirteen. With such a small population, the slightest change in numbers can cause a significant change to percentages. To obtain trend data, staff aggregated the minority categories into one group. Therefore, employment trend data was examined by comparing the non-minority population (White) to the minority population (Black/African American, Hispanic or Latino, Asian, and American Indian).

Employment data for minorities shows an upward trend in successful employment outcomes. Successful closures for minorities have been on a steady increase since FY2003 when the success rate (status 26) was 36.4%. In FY2008, the successful employment rate for minorities was 58.8%, compared to 65.7% for non-minority clients.

Educational Attainment
The percentage of Iowans whose highest level of educational attainment is a high school degree is 35.60%, followed by some college with no degree (20.4%). The percentage of Iowans who have a high school degree or higher is 89.60%.

Like Iowa's population, the percentage of clients whose highest level of educational attainment is a high school degree or equivalent is the highest percentage in the Department's closure population at 29.83%. On average, clients with some post-secondary education with no degree represent 21.44% of the closure population and those with a Bachelor's degree represent 19.18% of the closure population. The average percentage of closed clients with a high school degree or higher is 91.4%.

The Department's closure data shows those with more education close more successfully than those with less education. Clients who have a degree higher than a high school diploma close successfully at a high rate: Associates degree 69.47%; Bachelors degree 78.01%; and Masters degree: 75.54%. Those with a high school education closed successfully (status 26) on average 60% of the time. However, the data shows a downward trend in employment success for these clients. Individuals with a high school degree or equivalent were closing more successfully than those with a post-secondary, no degree education until FY 2008. Clients with a post-secondary, no degree education are on an upward trend for successful closures (status 26); they are also on a downward trend for unsuccessful closures (status 28).

Location of Residence
According to Census and U.S. Office of Management and Budget (OMB) estimates from 2006, 55.2% of Iowans live in a metropolitan area and 44.8% live in non-metropolitan areas (comprised of rural and micropolitan areas). A micropolitan area is an urban area based around a core city or town with a population of 10,000 to 49,999. Iowa has nine metropolitan areas consisting of twenty counties in Iowa and eleven out-of-state counties, and it has six micropolitan areas consisting of seventeen Iowa counties and two out-of-state counties. The remaining 62 counties in Iowa are considered rural areas.

On average, 30% of closed VR clients were from a rural or micropolitan area and nearly 60% were from a metropolitan area. The Department's client representation from metro areas is above that of the distribution of Iowa's population: 55.2% from Metro and 44.8% Non-Metro. (The Department also closed a small number of clients who are residing out of state or whose residence was unknown.)

Trend data shows that the Department is increasingly drawing clients from the metropolitan areas. In FY 2008, 63.21% of closed clients lived in a metropolitan area. At the same time, the percentage of clients coming from the micropolitan areas, like Boone, Burlington, Fort Dodge, and Newton, has been dropping. In FY2005, 16% of closed clients lived in a micropolitan area compared to 9.84% in FY2008. The number of closed clients from rural areas has remained fairly steady at an average of 30%.

Using data from four years, the average closure rates for these areas are:

Metro: Closed Status 26 - Successful 68%; Closed Status - 28 Unsuccessful 19%
Rural: Closed Status 26 - Successful 62%; Closed Status - 28 Unsuccessful 18%
Micro: Closed Status 26 - Successful 53%; Closed Status - 28 Unsuccessful 25%

VR clients living in metropolitan areas close successfully more often than those living in non-metro areas. Clients living in rural areas close successfully more often than those living in micropolitan areas. Clients living in micropolitan areas have the highest Closed Status - 28 Unsuccessful percentage.

Closure data suggests that the Department needs to focus efforts both in terms of increasing referrals from the micropolitan areas and in seeking ways to improve employment outcomes for residents living in these areas.

Services to Veterans

The 2007 American Community Survey estimates that veterans comprise 11% of Iowa's population. Currently Iowa's Veterans Administration has a record of 275 veterans that are legally blind. The majority of those veterans (80%) are aged 70 and older. Only 8% or 22 veterans are younger than 60 years old. The Department has closed the cases of twelve veterans in the last four years; six of those were in FY2008.

Co-Disabilities

Because secondary disabilities can have an impact on the client's VR services and employment, staff reviewed the incidences of secondary disability among closed clients for this needs assessment. The data showed that an average of 43.4% of closed clients had a secondary disability. Data trends from FY2005 to FY2008 show that clients with a secondary disability are less likely to close successfully than those who do not have a secondary disability. Employment outcomes showed that those with a secondary disability close successfully 56.2% of the time on average, compared to 68.3% for those without a secondary disability. In FY2008, 55.1% of clients with a secondary disability closed successfully compared to 70.4% of those without a secondary disability. The unsuccessful (status 28) rate for clients with a secondary disability averages to 18%; it was 14% for those without a secondary impairment.

Predicting the impact of secondary disabilities on client outcomes and developing strategies to address them is difficult for several reasons. First, the list of disability codes available for recording a secondary disability is both long and incomplete. The most frequently selected secondary impairment option for our VR clients is "Other Physical Impairments (not listed above)". This option is selected because the list of valid options does not include an option that best describes the client's impairment. Second, a client may have multiple impairments. However, the Counselor may only select a primary and secondary impairment. Third, the presence of an additional impairment is often made through client self-report or the Counselor's observation. Additional medical data is requested when significant conditions are reported, such as diabetes, heart conditions, cancer, stroke, brain injury, etc. However, some conditions may not be reported or observed. Despite these difficulties, the closure data indicates the Department may need to look at ways of improving employment outcomes for those clients whose record reflects the presence of a secondary impairment.

Satisfaction with VR Services

Five years of closure surveys were analyzed to determine client satisfaction with services and the level of effectiveness of training. Client satisfaction surveys are sent at case closure to clients whose case closed successfully and unsuccessfully. The average response rate is 41%. On average, 90% of respondents indicated they were currently employed in either a paid job, as a volunteer, or as a homemaker, 8% were not, and 2% did not answer.

Overall, survey respondents were satisfied with the services they received. More than 90% of respondents indicated that they understood the VR process and the services available. Most felt the services that they received were timely (87%) and helpful (77%). Nearly 90% of respondents indicated that they felt better about themselves and their future after receiving services. Eighty-nine percent indicated that they felt they were a "more competent and independent person because of the rehabilitation services I received."

The purchase of training or occupational tools was cited most frequently as the most valuable service received, followed closely by guidance from the Vocational Rehabilitation Counselor or Teacher.

Supported Employment

Supported employment is defined as "competitive employment in an integrated setting or employment in integrated work settings in which individuals are working toward competitive employment consistent with the strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice of the individuals with ongoing support services for individuals with the most significant disabilities."

Traditionally, a small percentage of the Department's clients receive supported employment services. Many of those clients who receive supported employment services close in employment without supports. The FY2008 closure data shows that twelve clients had supported employment services on their plan. Of those, three closed successfully in supported employment, six closed successfully in employment without supports, and three closed unsuccessfully. Data trends show that, while few clients receive supported employment services, those who do receive these services close successfully at a high rate in either supported employment or employment without supports. Because these intensive services are successful for those who require them, the Department plans to enhance its supported employment program to ensure that those clients who could benefit from supported employment services receive them.

Recently, the Department began working with staff from Iowa Vocational Rehabilitation Services (IVRS) to implement the IVRS supported employment model. This model is designed to increase successful supported employment outcomes by ensuring that staff from the VR agencies and CRPs understand their roles and are clear about the training objectives and services to be provided.

Assessment of Services to Individuals with Disabilities Provided by Other Components of the Statewide Workforce Investment System

The Iowa agencies in the statewide workforce investment system, including the Department and Iowa Vocational Rehabilitation Services, have a strong, collaborative relationship. Attachment 4.11(d) details a number of joint activities designed to improve the employment outcomes of all Iowans with disabilities. Data from Iowa Workforce Development (IWD) estimates that 11.2% of exiting clients had a disability in program year 2008. IWD feels that many job seekers using services do not self-disclose their disability. A recent comparison of Social Security Ticket to Work ticket-holder data to IWD data showed that more individuals with disabilities utilized services than was reported.

Department staff have been encouraging more clients to utilize the services offered through the workforce partners, such as participation in job clubs, resume preparation, job interviewing skills, and Wagner-Peyser programs. Traditionally, the Department has served as a technical assistance resource for the One-Stop Centers in Iowa.

Potentially, both One-Stop Center staff and our VR clients would benefit from increased usage of the Workforce services. Our clients would benefit from the job seeking expertise the One-Stops offer. One-Stop Center staff would gain experience in working with job seekers who are blind or visually impaired and would be able to report provision of services to these individuals. IWD data from March 2009 showed that 7% of the Department's open VR clients were also registered with at least one of their programs.

Iowans with disabilities who work also have the option of receiving Medicaid coverage from the Medicaid for Employed Persons with Disabilities (MEPD) program (Iowa's Medicaid Buy-in program). The MEPD program is operated by the Iowa Department of Human Services. March 2009 data from the MEPD program show that 21% of the Department's current VR clients participate in this program.

Assessment of the need to establish, develop, or improve community rehabilitation programs in Iowa

By July 2009, the Department and IVRS will have signed agreements with 87 Community Rehabilitation Programs (CRPs) throughout the state. These agreements detail the types of services the CRP will provide and methods for payment of services. By working together, the Department and IVRS will ensure that CRPs receive consistent information and direction from the VR agencies in Iowa.

In most instances, Department staff provide assessments, training, and job seeking services to blind and visually impaired clients who require supported employment services, as we have found this to be the most effective and expeditious manner in delivering these services. However, the Department uses CRPs throughout Iowa when necessary for job coaching, client assessments, training, or placement in supported employment.

In spring 2009, surveys were sent to 66 CRPs throughout the state. This survey had a 39% response rate. Fifty-two Iowans who are blind or visually impaired received services from eighteen of the responding organizations in the 2008 calendar year. The majority of survey respondents assessed their organization's ability to provide employment related services to blind or visually impaired individuals as either good (36%) or adequate (40%). Of those indicating that their organization needs improvement in this area (24%), all requested training from Department staff. (Arrangements to provide training have been made.) Most of the respondents indicated that they had worked with either VR or Independent Living staff from the Department, and several provided positive comments regarding the collaboration. Unfortunately, only a few (20%) indicated that they had made referrals to the Department.

Based on survey results, the Department feels that it has good working relationships with the CRPs with which we have worked. However, we would like to have more referrals from these community resources. New outreach efforts are designed to make both the general public and service providers aware of the Department's services and therefore increase referrals. Lastly, while the response rate was satisfactory, we were not able to assess the services of 61% of the CRPs identified in the state. With the implementation of IVRS's supported employment model, we hope to obtain more information about these providers.